Systematic Review and Meta-analysis: Outcomes After Descemet Membrane Endothelial Keratoplasty Versus Ultrathin Descemet Stripping Automated Endothelial Keratoplasty

Maier, Anna-Karina B.; Milek, Jonas; Joussen, Antonia M.; Dietrich-Ntoukas, Tina; Lichtner, Gregor

doi:10.1016/j.ajo.2022.09.013

Cited by 14 publications

(39 citation statements)

References 46 publications

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Section: Discussionmentioning

confidence: 99%

“…During the review process of this this article, another meta-analysis by Maier AB and colleagues also showed more improvement in BCVA in patients who undergo DMEK over UT-DSAEK with higher re-bubbling rate with the DMEK group. 26 Majority of grafts in the included studies were prepared using a microkeratome, with pre-procedure corneal thickness recording done with a pachymeter, in order to decide the required microkeratome head size to achieve the targeted graft thickness of 70-130 microns. 11 In the present review, the pre-operative central corneal thickness (CCT) values were mentioned in four studies, with all of them having a corneal thickness between 600 and 700 microns.…”

Section: Discussionmentioning

confidence: 99%

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Is ultra-thin Descemet stripping automated endothelial keratoplasty a viable alternative to Descemet membrane endothelial keratoplasty? A systematic review and meta-analysis

et al. 2023

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Background: Ultra-thin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) is a recently developed surgical procedure that has shown promising results for the management of various corneal endothelial diseases. Objectives: To evaluate the outcomes of the UT-DSAEK to the Descemet membrane endothelial keratoplasty (DMEK). Design: A systematic analysis of the studies comparing UT-DSAEK with DMEK by evaluating one or more outcomes (vision, complications, and post-operative endothelial cell counts) was performed. The meta-analysis was done if two or more studies reported a common outcome. Methods: We used PubMed, EMBASE, and SCOPUS databases to identify articles comparing the outcomes of UT-DSAEK with DMEK and performed a meta-analysis using RevMan, version 5.4. Results: A total of six studies were included in this review (two randomized clinical trials and four non-randomized comparative studies). Our analysis showed the patients who underwent DMEK cases showed better visual outcomes with a mean difference of 0.06 LogMAR (95% CI: 0.04–0.09) in BCVA, albeit with i2 of 52% (heterogenous values). The evidence was weak, with the most weightage on retrospective studies. UT-DSAEK showed significantly fewer complications such as graft dislocations, with an odds ratio of 0.25 (95% CI: 0.13–0.48). There was no significant difference in the endothelial cell counts with a mean difference of 86.34 (95%CI: –133.09 to –305.77). Conclusion: Although the literature is limited on UT-DSAEK with post-operative visual acuity that could be practically at par with DMEK, lesser complication rates and comparable post-operative endothelial cells could be a suitable alternative to DMEK for corneal endothelial pathologies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Is ultra-thin Descemet stripping automated endothelial keratoplasty a viable alternative to Descemet membrane endothelial keratoplasty? A systematic review and meta-analysis

et al. 2023

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“…To the best of our knowledge, the present meta-analysis is the first in the literature that compares exclusively UT-DSAEK and DMEK in terms of efficacy and safety in patients with FED or PBK and with no other ocular comorbidities. In parallel with us, another team worked on the same topic and they managed to publish their meta-analysis earlier (30). Even if our results are similar, we have to mention that they have included in the UT-DSAEK group, 28 patients that underwent Nanothin-DSAEK (NT-DSAEK) (31).…”

Section: Discussionmentioning

confidence: 82%

Ultrathin-Descemet Stripping Automated Endothelial KeratoplastyVersusDescemet Membrane Endothelial Keratoplasty: A Systematic Review and Meta-analysis

Dimtsas

Moschos

2023

In Vivo

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Background/Aim: The aim of this meta-analysis was to compare the efficacy and safety of Ultrathin -Descemet stripping automated endothelial keratoplasty (UT-DSAEK) versus Descemet membrane endothelial keratoplasty (DMEK) for the treatment of corneal endothelial failure in patients with Fuchs endothelial dystrophy (FED) or Pseudophakic bullous keratopathy (PBK). Patients and Methods: We performed a meta-analysis and conducted a literature search in PubMed and Cochrane Library, following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Effects were calculated as odds ratios or standardized mean differences. Results: A total of six studies with 300 eyes in total (151 UT-DSAE and 149 DMEK) were included. BSCVA was superior in the DMEK group compared with the UT-DSAEK at 3, 6, and 12 months after surgery. Rebubbling rates and overall adverse events were 2.37 and 1.48 times, respectively, higher in the DMEK group. The central corneal thickness and spherical equivalent were significantly lower in the DMEK group 12 months post-surgery. Endothelial cell density values were similar in both groups up to 12 months postoperatively. Conclusion: To the best of our knowledge, this is the first meta-analysis comparing UT-DSAEK with DMEK. DMEK surgery resulted in significantly better BSCVA at 3, 6, and 12 months postoperatively compared to UT-DSAEK. UT-DSAEK had a better complication profile with lower rebubbling rates.

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“…1,2 In 2014, more than 40% of all corneal grafts were used to treat corneal endothelial diseases. [1][2][3] Endothelial keratoplasty, which involves implanting a healthy cadaveric Descemet membrane (DM) lined with endothelial cells over the posterior surface of the recipient cornea, is now the gold standard of care for corneal endothelial failure. Descemet stripping automated endothelial keratoplasty (DSAEK) and DM endothelial keratoplasty (DMEK), have been demonstrated to provide highly satisfying visual outcomes.…”

mentioning

confidence: 99%

“…Descemet stripping automated endothelial keratoplasty (DSAEK) and DM endothelial keratoplasty (DMEK), have been demonstrated to provide highly satisfying visual outcomes. [1][2][3] However, global corneal donor shortage is a notable concern for corneal transplantation (1 donor available per 70 patients). 4 Diverse solutions including split-cornea transplantation for two recipients, hemi-DMEK, quadri-DMEK, and descemetorhexis without endothelial keratoplasty (DWEK) were proposed to overcome this problem; however, these approaches have not been adequately and effectively tested in the scientific literature.…”

mentioning

confidence: 99%

Effects of Autologous Serum and Platelet-Rich Plasma on Human Corneal Endothelial Cell Regeneration: A Comparative Study

Kilic-Toprak,

Cort-Donmez,

Toprak

2023

Eye &Amp; Contact Lens: Science &Amp; Clinical Practice

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Objectives: To investigate the effects of autologous serum (AS) and platelet-rich plasma (PRP) on human corneal endothelial cell (HCEC) proliferation and apoptosis in comparison to Y-27632 as the commonly studied Rho-associated kinase (ROCK) inhibitor. Methods: The human corneal endothelial primary cell line was used for this study. As the treatment groups, HCECs were incubated with AS, PRP, and Y-27632, whereas the control group received no treatment. Cell proliferation (measured by 5-bromo-2′-deoxyuridine [BrdU] incorporation) and apoptosis (based on the caspase-3 level) were compared between the control, Y-27632, AS, and PRP groups. Results: In the Y-27632, AS, and PRP groups, the ratios of BrdU-incorporated cells were significantly higher (115±0.2%, 125±0.2%, 122±0.4% at 24 hr, and 138±2.4%, 160±0.2%, 142±0.2% at 48 hr, respectively) than in the control group (100±18.4% at 24 hr, 100±1.1% at 48 hr) (P<0.05 for all). Furthermore, AS provided a higher HCEC proliferation ratio compared with the Y-27632 group at 24 and 48 hr (P<0.05 for all). Caspase-3 was significantly lower in the AS group (60.3±3.3%) than in the control (100±2.3%), Y-27632 (101.9±5.2%), and PRP (101±6.8%) groups (P<0.05 for all). Conclusions: The results of this study demonstrated for the first time that AS and PRP promoted HCEC proliferation and AS significantly decreased apoptosis in HCECs. A superior effect on HCEC proliferation was also observed with AS compared with Y-27632. Future “autologous” regenerative therapeutic options for corneal endothelial failure may involve the utilization of AS and PRP owing to their accessibility, simplicity in preparation, immunologic compatibility, and donor-free nature.

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Systematic Review and Meta-analysis: Outcomes After Descemet Membrane Endothelial Keratoplasty Versus Ultrathin Descemet Stripping Automated Endothelial Keratoplasty

Cited by 14 publications

References 46 publications

Is ultra-thin Descemet stripping automated endothelial keratoplasty a viable alternative to Descemet membrane endothelial keratoplasty? A systematic review and meta-analysis

Is ultra-thin Descemet stripping automated endothelial keratoplasty a viable alternative to Descemet membrane endothelial keratoplasty? A systematic review and meta-analysis

Ultrathin-Descemet Stripping Automated Endothelial KeratoplastyVersusDescemet Membrane Endothelial Keratoplasty: A Systematic Review and Meta-analysis

Effects of Autologous Serum and Platelet-Rich Plasma on Human Corneal Endothelial Cell Regeneration: A Comparative Study

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